Antenatal care quality and its effect on nutrition interventions

Abstract

Essential nutrition interventions for pregnant women such as iron‐folic acid and calcium supplementation are most frequently delivered through clinic‐based antenatal care (ANC). However, ANC is frequently of poor quality, reducing the impact of these interventions and women's uptake of these services. In order to evaluate ANC quality and describe recipient and provider perspectives of ANC quality, we performed a mixed‐methods study composed of direct observations of ANC consultations (n=999), an exit survey with ANC recipients (n=582) and qualitative interviews with ANC providers (n=20) in central Haiti.Observation results revealed that few providers deliver ANC in accordance with national or WHO guidelines. When asked to identify components of high‐quality care, ANC providers cited physical measurements, such as blood pressure and uterine height, necessary equipment and nutrition supplements. Few providers identified non‐tangible components such as counseling, education or communication as elements of high‐quality ANC. Consequently, a low proportion of women could state why they received the services they did or were informed of their own lab results. These findings show that ANC providers tend to give less emphasis to information, education and communication, which is likely to limit the effectiveness of nutritional interventions of ANC.